Insulin Resistance

The purpose of this page is to explain to you what insulin resistance is, that it is linked to many other health conditions, what to look for to suspect if you have insulin resistance and how to treat insulin resistance.

Definition-

"Insulin stimulates glucose to enter into tissue, and its ability to do so varies greatly among individuals. In insulin resistance, tissues have a diminished ability to respond to the action of insulin. To compensate, the pancreas secretes more insulin.

Insulin resistance can be linked to diabetes, hypertension, abnormal cholesterol, cardiovascular disease (heart attacks and strokes) and other abnormalities. These abnormalities constitute the insulin resistance syndrome. Because insulin resistance usually develops long before these diseases appear, identifying and treating insulin-resistant patients has potentially great preventive value.

Obesity, type 2 diabetes, hypertension, lipid disorders, and heart disease are common in most Western societies and are collectively responsible for an enormous burden of suffering. Many people have more that one and sometimes all of these conditions, leading to the theory that the coexistence of these diseases is not a coincidence, but that a common underlying abnormality allows them to develop. In 1988 it was suggested that the defect was related to insulin, and the insulin resistance syndrome was first described. It is estimated that this syndrome affects 70-80 million Americans." American Family Physician-March 2001

When to suspect insulin resistance- There is no simple and practical test that can detect insulin resistance. Therefore physicians use the below list to know when to suspect insulin resistance.

Family history of diabetes

Hypertension -(1/2 of patients with hypertension have insulin resistance)

Intense carbohydrate cravings, sweet tooth, or “highs and lows” after too many carbs

History of gestational diabetes or history of babies weighing more than 9lbs.

Weight gain the first year after pregnancy

Polycystic ovary syndrome

Obesity- The pattern of obesity is extremely important. There is a strong relationship between abdominal obesity and the degree of insulin resistance independent of total body weight.

History of new onset of obesity or worsen of obesity during midlife- i.e. “I never had a weight problem till I hit 40” or “I didn’t use to have to work near this hard to lose weight”

A history of change of where your body distributes fat. Holding more weight around your middle than you use to. “I never use to have such a thick waist.”

Also I suspect insulin resistance when I see a mismatch in weight loss and a great journal, i.e. a documented month of hitting the target approach and only losing 2-3 lbs. This tells me that something additional must be contributing to weight problems.

If some or all of these problems fit you, you may have insulin resistance.

How to treat insulin resistance

Many studies have shown that treating insulin resistance results in weight loss (the reverse is also true - that losing weight improves insulin resistance). As suspected, treating insulin resistance improves the other disease linked to it.

Metformin has been the most frequently used drug in the treatment of diabetes. Metformin has been used in the United States for five years, and world wide for about 16 years. The most practical test to see if metformin would benefit you, is to use it in a 4-8 week trial and observe for a response. The response you may see is reduction in hunger and cravings, especially sweet cravings. You may notice less energy dips during the day, like that 3pm slump.

The side effects of metformin can be serious if you do not follow two important rules:

1. Stop metformin if you are to have an X-ray that requires IV dye. Dye used in some X-rays can compromise your kidneys. Metformin depends on healthy kidneys to filter it out of the body.

2. Dehydration. This is usually unheard of in my patients, but if you were in a situation of unavoidable dehydration, like vomiting and severe diarrhea. Then you would temporally stop the metformin until you were back to normal.

Metformin like many drugs could accumulate in your body if your kidneys are not functioning or if you are dehydrated. This could result in a life threatening condition called lactic acidosis. You may notice some nausea and diarrhea when you first start metformin. This can be avoided by gradually working up to the dose prescribed.